Role of Mucosal Inflammation in Eosinophilic Esophagitis: Review of the Literature

Eosinophilic esophagitis (EE) is increasingly recognized in adults. It is an inflammatory disease of the esophageal mucosa, with variable presentation, unresponsive to acid suppression therapy. The diagnosis requires histological confirmation of intense eosinophilic infiltration on esophageal biopsy specimen, however exact criteria required to make a diagnosis of EE is still being debated and a clear differentiation from gastroesophageal reflux disease (GERD) is important. Allergen elimination or anti-inflammatory therapy may be effective in such patients. The imperfect diagnostic criteria for EE mandate an understanding of the immunology and the pathophysiology of the disease. It may facilitate the introduction of novel treatment modalities in an individual unresponsive to acid suppression therapy. This paper describes basic elements of the immune-mediated injury to the esophageal mucosa and management aspects to provide a better understanding of the condition.

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Do Eosinophil Numbers Differentiate Eosinophilic Esophagitis from Gastroesophageal Reflux Disease?

Archives of Pathology & Laboratory Medicine ◽

10.5858/134.6.815 ◽

2010 ◽

Vol 134 (6) ◽

pp. 815-825

Author(s):

Muriel Genevay ◽

Laura Rubbia-Brandt ◽

Anne-Laure Rougemont

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Eosinophilic Esophagitis ◽

Reflux Disease ◽

Eosinophilic Infiltration ◽

Treatment Modalities ◽

Esophageal Mucosa ◽

American Gastroenterological Association ◽

National Library

Abstract Context.—Although the healthy esophageal mucosa contains no eosinophils, eosinophilic infiltration is observed in 2 major clinicopathologic settings: gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EE). The prevalence of EE is increasing in many countries, and this increase seems only partly to be due to a better awareness of the pathology, following the relatively recent description of EE. Gastroesophageal reflux disease and EE represent 2 entities that do not respond to the same treatment modalities and, thus, need to be distinguished. However, diagnostic criteria of EE have been defined arbitrarily, and the more recent articles tend to prove that the overlap with GERD is probably greater than initially believed, leading the authors to advise strict exclusion of GERD before considering the diagnosis of EE. Objectives.—To provide pathologists with the currently proposed histologic criteria of GERD and EE, to stress the need to combine these criteria with clinical data and endoscopic findings, and to outline the remaining controversies. Data Sources.—This review is based on selected articles identified by a PubMed (US National Library of Medicine, Bethesda, Maryland) search of the literature in English for GERD and EE, a recent review by the American Gastroenterological Association (Bethesda), the Proceedings of the First International Gastrointestinal Eosinophil Research Symposium, and the authors' experience. Conclusions.—Proper identification of the etiology of eosinophilic infiltration of the esophagus allows accurate medical or surgical treatment and follow-up. Eosinophilic esophagitis and GERD diagnoses require integration of the histologic findings with the clinical and endoscopic data.

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Eosinophilic Esophagitis: Atopy Conditions of the Esophagus

Archives of The Medicine and Case Reports ◽

10.37275/amcr.v2i3.25 ◽

2021 ◽

Vol 2 (3) ◽

pp. 154-166

Author(s):

Puspa Zuleika

Keyword(s):

United States ◽

Food Allergy ◽

Eosinophilic Esophagitis ◽

The United States ◽

Esophageal Stenosis ◽

Esophageal Mucosa ◽

High Power Field ◽

Immune Mediated ◽

Food Antigens ◽

Delays In Diagnosis

Eosinophilic esophagitis is an immune-allergic pathology of multifactorial etiology(genetic and environmental) characterized by major symptoms of esophagealdysphagia and eosinophil-predominant inflammation of the esophageal mucosathat affects both pediatric and adult patients. EoE is an immune-mediated diseaseby which environmental and food antigens stimulate the Th2 inflammatorycascade. It is correlated with food allergy and atopy condition such as asthma, atopydermatitis, rhinitis allergic and often in conjunction with Gastroesophageal RefluxDisease (GERD). Eosinophilic esophagitis (EoE) was first described in the 1990s,showing an increasing incidence and prevalence since then, in the United States isestimated to be approximately 57 per 100,000 persons being the leading cause offood impaction and the major cause of dysphagia. Its symptoms, which includeheartburn, regurgitation, and esophageal stenosis. This symptomps similar to thoseof gastroesophageal reflux disease, causing delays in diagnosis and treatment. Theendoscopic findings such as furrows, esophageal mucosa trachealization, andwhitish exudates, this diagnosis should be confirmed histologically confirmed bybiopsy on the presence of more than 15 eosinophils per high-power field and theexclusion of other causes of eosinophilia. Management includes medications, diet,and surgical dilatation.

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Clinical Guidelines of the Russian Gastroenterological Association on the Diagnostics and Treatment of Eosinophilic Esophagitis

Russian Journal of Gastroenterology Hepatology Coloproctology ◽

10.22416/1382-4376-2018-28-6-84-98 ◽

2019 ◽

Vol 28 (6) ◽

pp. 84-98 ◽

Cited By ~ 4

Author(s):

V. T. Ivashkin ◽

I. V. Maev ◽

A. S. Trukhmanov ◽

T. L. Lapina ◽

D. N. Andreev ◽

...

Keyword(s):

Eosinophilic Esophagitis ◽

Clinical Manifestations ◽

Eosinophilic Infiltration ◽

Esophageal Mucosa ◽

High Power Field ◽

Immune Mediated ◽

Esophageal Dysfunction ◽

Diagnostic Criterion ◽

Choice Of Therapy

Aim.This paper presents guidelines on the diagnostics and treatment of eosinophilic esophagitis, which can be used by practitioners in their everyday practice.Summary.Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized by the symptoms of esophageal dysfunction and a pronounced eosinophilic infiltration of the esophageal mucosa. The EoE diagnostics is based on the clinical manifestations of the disease (dysphagia, food impaction, chest pain regardless of swallowing), as well as on the combination of endoscopic and histological signs. The diagnostic criterion is the eosinophilic infiltration of the esophageal mucosa with an eosinophil density of ≥ 15 per high power field (×400) in at least one of the biopsy specimens (about 60 eosinophils in 1 mm2). Total IgE levels, peripheral blood eosinophilia and skin allergy tests are considered to be additional diagnostic means. Several approaches are used for the treatment of EoE, including proton pump inhibitors (PPIs) and topical glucocorticosteroids (GCS), as well as elimination diets. The choice of therapy should be individualized, with the mandatory assessment of the treatment efficacy after 6–12 weeks using esophagogastroduodenoscopy with biopsy sampling. Endoscopic dilatation should be considered in patients suffering from severe dysphagia due to esophagus stricture.Conclusion.Increased incidence of EoE predominantly among children and young people, as well as its chronic character requiring long-term maintenance therapy, make EoE a significant issue to the practice of gastroenterology.

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Eosinophilic esophagitis in children: Updates and practical aspects of management for allergists in a non‐tertiary care private practice setup

Allergy and Asthma Proceedings ◽

10.2500/aap.2022.43.210084 ◽

2022 ◽

Vol 43 (1) ◽

pp. 5-11 ◽

Cited By ~ 1

Author(s):

Ejaz Yousef ◽

Yelena Korotkaya ◽

Alyson B. Simpson

Keyword(s):

Eosinophilic Esophagitis ◽

Private Practice ◽

Immunoglobulin E ◽

Therapeutic Option ◽

Tertiary Care ◽

Elemental Diet ◽

Dietary Therapy ◽

Steady Increase ◽

Esophageal Mucosa

Background: Eosinophilic esophagitis (EoE) is a chronic immune and/or antigen-mediated disease characterized by eosinophilic infiltration of mucosa (≥15 eosinophils per high power field) without any secondary etiology. Non‐immunoglobulin E mediated mechanisms predominate in EoE. Objective: This review concentrated on a stepwise approach for the allergist working in non‐tertiary care private practice. Methods: A medical literature search that focused on several areas of the latest developments in the diagnosis and management of EoE was conducted. Results: There has been a steady increase in the prevalence and incidence of EoE. Clinical symptoms can vary from dysphagia to failure to thrive, depending on the age at presentation; some children develop adaptive behaviors to compensate for dysphagia, such as food preferences and slow eating. The diagnosis is based on a high index of clinical suspicion and is confirmed with endoscopy with biopsies after ruling out other causes of esophageal eosinophilia. Treatment options may include dietary therapy, pharmacologic therapies, or combination therapy. Therapeutic options may also include endoscopic dilation for stricturing disease. Conclusion: Providers should be aware of recent recommendation changes in the diagnostic workup, the role of skin-prick testing, and role of the proton-pump inhibitor as first-line therapy for EoE. Also, clinicians should be aware of the emerging role of empiric dietary therapy as a preferable therapeutic option when compared with the testing-directed diet and the elemental diet. Furthermore, topical glucocorticoid therapies are available, and new developing therapies are being investigated. Reevaluation of esophageal mucosa with biopsies is required approximately 2 months after therapy for a response and after a change in therapies to confirm continued resolution.

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Role of Biopsy from Gastric Corpus in Diagnosis of Helicobacter pylori Infection in Patients on Acid Suppression Therapy

Medical Journal Armed Forces India ◽

10.1016/s0377-1237(03)80010-2 ◽

2003 ◽

Vol 59 (3) ◽

pp. 216-217

Author(s):

AK Seth ◽

S Kakkar ◽

GS Manchanda

Keyword(s):

Helicobacter Pylori ◽

Helicobacter Pylori Infection ◽

Acid Suppression ◽

Acid Suppression Therapy ◽

Gastric Corpus

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Eosinophilic Esophagitis: Atopy Conditions of the Esophagus

Archives of The Medicine and Case Reports ◽

10.37275/amcr.v2i1.27 ◽

2021 ◽

Vol 2 (1) ◽

pp. 146-157

Author(s):

Puspa Zuleika

Keyword(s):

Eosinophilic Esophagitis ◽

Reflux Disease ◽

The United States ◽

Esophageal Stenosis ◽

Esophageal Mucosa ◽

High Power Field ◽

Inflammatory Cascade ◽

Immune Mediated ◽

Food Antigens ◽

Delays In Diagnosis

A B S T R A C TEosinophilic esophagitis is an immune-allergic pathology of multifactorial etiology(genetic and environmental) characterized by major symptoms of esophagealdysphagia and eosinophil-predominant inflammation of the esophageal mucosa thataffects both pediatric and adult patients. EoE is an immune-mediated disease bywhich environmental and food antigens stimulate the Th2 inflammatory cascade. It iscorrelated with food allergy and atopy condition such as asthma, atopy dermatitis,rhinitis allergic and often in conjunction with Gastroesophageal Reflux Disease(GERD). Eosinophilic esophagitis (EoE) was first described in the 1990s, showing anincreasing incidence and prevalence since then, in the United States is estimated tobe approximately 57 per 100,000 persons being the leading cause of food impactionand the major cause of dysphagia. Its symptoms, which include heartburn,regurgitation, and esophageal stenosis. This symptomps similar to those ofgastroesophageal reflux disease, causing delays in diagnosis and treatment. Theendoscopic findings such as furrows, esophageal mucosa trachealization, and whitishexudates, this diagnosis should be confirmed histologically confirmed by biopsy onthe presence of more than 15 eosinophils per high-power field and the exclusion ofother causes of eosinophilia. Management includes medications, diet, and surgicaldilatation.

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